Spring has sprung and we are on our way to summer! It is the time of the year when our children spend hours of their day outdoors: at the playground, the swing set in the backyard, biking and playing sports. It is also the time of the year when dentists begin to see an uptick of emergency visits to the office for children who have sustained dental injuries while enjoying one of the aforementioned outdoor activities. No matter what caused the injury, if bleeding or bruising occurred in the mouth or on the lip, chances are that the force of the injury was strong enough to impact the teeth. If such an injury was sustained, your child should be seen by a dentist soon after. There are many different types of dental trauma, and the dentist will evaluate the face and jaw, determine the extent of the injury and advise the appropriate action.
Some of the more serious dental-related sports injuries involve fractures of the alveolar bone (the bone that the teeth are set in) and of the upper or lower jaw. Such injuries may require wiring the jaw or surgery. The soft tissue of the face, lips and gums is also frequently injured during sports-related injuries. Deep cuts on the lips may require stitches, and in some cases cuts to certain areas of the gum may need stitches as well. If a child falls hard on the face and in the process bites down with great force on the tongue, a deep cut on the tongue may also require stitches. The most common dental-related injuries in children as a result of sports accidents, however, are injuries to the teeth themselves.
Primary teeth (“baby teeth”) injuries
When a child with primary teeth sustains a dental injury, the important thing to consider is not only the damage to the primary tooth, but to the permanent tooth forming directly behind the root of that tooth. When a child falls face-forward or gets hit in the mouth with an object, a tooth may be hit hard and injured, but not show any external injury. This sort of injury can cause damage to the blood vessels supplying that tooth, or to the surrounding ligament. In such a case, the tooth may feel a little loose, and may discolor immediately or even weeks later. This tooth may recover and last until it is naturally lost, or may need nerve treatment later on. Discoloration may be gray or brown in color, and does not necessitate the extraction of that tooth. Your dentist will take an x-ray of the tooth and likely monitor the tooth for any signs of infection.
When the tooth is hit hard enough it may in fact move; this movement may be forwards, backwards or inwards into the socket. In all those case, while the prognosis for the long term is guarded, the immediate treatment may be nothing at all. If a primary tooth is displaced in any direction, unless the new position of the tooth is preventing the child from biting down completely, the tooth is not moved back into the original position. In any of those cases, the tooth may develop an infection in the future and need to be removed. If a primary tooth is knocked out completely from the trauma, unlike in the case of an adult tooth, it is not put back into the socket. If the crown of the tooth is fractured, the treatment is decided based on the size of the fracture; if it is very small, the area may just need to be smoothed, or possibly fixed with white filling material. If the fracture is very large the tooth may need to be removed.
Permanent teeth injuries
The main difference between accidents involving primary teeth and permanent teeth is the long-term follow-up care. A permanent tooth that has been hurt in any serious way has to be monitored for signs that a root canal is required. This is most often the outcome when a permanent tooth is hit hard enough so that it moves in any direction in the socket, is significantly fractured or if it is completely knocked out. It is important to remember that a permanent tooth that has been knocked out can be replaced into the socket, providing it is done within a short time after the accident (a dentist should ideally be seen within an hour of such an accident). Until seeing the dentist, keep an ice pack on the area to reduce swelling, and the tooth should be kept immersed in a cup of milk or saline, not water. If a tooth is fractured and the pieces of the broken part are found, those pieces should be brought to the dentist as well in a cup of milk or saline. If after an accident the adult tooth is loose, the dentist will likely place a wire splint on the tooth and advise a soft diet for two weeks. If the tooth was displaced as a result of the accident, the dentist will reposition it to the correct spot, place a wire splint and recommend the same dietary restrictions.
After any dental injury, if you are unable to bring your child to the dentist to have the injury assessed that day or even the next, take the precaution of keeping your child on a soft diet and avoid biting with the front teeth; make sure that food is cut up and put towards the back of the mouth. This should last for at least 10 days. Once the dentist evaluates your child’s injury you will have a better idea of what to expect for the future of the injured tooth. Most importantly, if your child is involved in sports like soccer or baseball, one of the best preventive measures you can take is to have your child fitted for a sports mouthguard. Play safe and have a wonderful summer!
Talya Gluck earned her BA from Barnard College in 2004. She attended dental school at University of Medicine and Dentistry of New Jersey and went on to complete a two-year Pediatric Dentistry residency in 2011. She is a board-eligible pediatric dentist and her research has been published in dental journals. She lives in NJ with her husband and three children.
Dr. Peikes grew up in New Jersey and completed dental and post-grad pediatric training at University of Medicine and Dentistry of New Jersey. He has published articles on sealants and received his board certification in 2013. Dr. Peikes, along with his wife, Elana, have three sons and reside in NJ.
By Dr. Tayla Gluck
and Dr. Daniel Peikes ,
Montville Pediatric Dentistry
